E3 Work Therapy Services
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Prevent: Employers, Business Owners, HR Professionals
Evaluate: Insurance Professionals, Nurse Case Managers, Doctors
Treat: Insurance Professionals, Nurse Case Managers
Assist: Attorneys, Paralegals, Legal Assistants

Deposition Preparation

An attorney armed with the right questions for a non-E3 FCE provider can ensure that FCE report, and testimony, is proven to be subjective and potentially biased. E3 knows these questions and can also anticipate varying reactions.

E3 Treatment Cap

E3 does not believe in "warehousing" clients who are ready to return to work and we believe strongly in the effectiveness of our work conditioning/hardening programs. As such, E3 work conditioning/hardening services will be offered at a 50% discount after 20 sessions as long as the following criteria are met:

  • The client is compliant with treatment (see In-treatment Validity of Effort Testing)
  • The client continues to make measurable and meaningful changes in functional status.
  • The client remains unable to return to regular or modified duty.

Expert Testimony

There are hundreds, maybe thousands, of FCE experts more than happy to give legal testimony based on an FCE report, theirs or any other. Nearly all of them are trained and expert in outdated FCE modalities. Generally they treat FCEs as a tertiary endeavor, focusing instead on wholly unrelated, non-work-comp therapy.

E3’s experts’ sole focus is on FCEs, specifically the only legally-defensible FCE protocol on the market and the differences between it and other protocols.

FCE Report Analysis

E3’s FCE experts can provide written assessments of an FCE Report, highlighting precisely where non-objective measures and flawed science were used during testing.

Functional Capacity Evaluations (FCE)

E3’s singular focus on Work Comp-related services is most evident in our approach to FCEs. Our uniquely accurate, fully-objective ‘validity of effort’ testing during an FCE begets evidence-based data that can be used to make appropriate therapeutic, medical and legal decisions.

The Problem:

  • Naturally, every FCE program has, at some point, proclaimed itself to be the gold standard, yet there has never been a substantial improvement to the original models.
  • Independent and peer-reviewed research has proven that they are all inherently flawed.
  • The common problem among all protocols is that effort during an FCE was "measured" using methods that have been scientifically proven to lack accuracy, relevance and most importantly, objectivity.

Stated another way: the assessing therapist makes a guess whether a claimant’s effort was "valid." The guess, ideally, was an educated guess based on years – even decades – of experience. The problem, of course, was how easily the exact opposite guess could be formulated – also by an FCE expert with decades of experience. This adversarial approach ultimately renders two FCEs a waste of time and money or it forces non-medically trained judges, attorneys and arbitrators to decide which measure of effort is "more objective".

By definition, nothing can be "more objective" – it is either objective, or it isn’t.

E3’s Validity of Effort testing is objective and legally defensible. Others are not. It really is that simple.

The Solution:

At no point does opinion influence E3’s measure of effort during an FCE. While gleaning the same amount and depth of information begotten by any FCE protocol, E3 therapists use the XRTS "Cross Reference Testing System" to objectively measure effort.

The research that supports XRTS inherent objectivity has been published in numerous peer-reviewed industry journals. XRTS has played an integral role in many recent court decisions, often being compared ‘head to head’ with outdated FCE protocols… and, interestingly, to the distinct benefit of both the injured party and the insurer.

The Solution Applied:

The E3 philosophy regarding FCEs is simple: It must be accurate, it must be objective and it must be legally defensible.

E3 also likes to make them accessible. To that end, E3 FCEs are available as a mobile service statewide. Other highlights of our FCE service include the following:

  • FCEs are scheduled and performed in less than 3 weeks – even sooner if necessary
  • Customized reports can be delivered to multiple recipients if needed. Reports are delivered in four business days (or less) after the completion of the test
  • Single point of contact for scheduling, questions and follow-up ensures timely and informative support for all E3 clients
  • The evaluating therapist will call the referral source immediately after testing to convey and discuss initial findings
  • Multiple permanent testing facilities across Iowa and a mobile testing service for clients with transportation issues and/or residing in rural locations
  • Every E3 FCE report is peer reviewed prior to distribution in order to ensure quality
  • Full litigation support services (including FCE Analysis, preparation for depositions and expert testimony) are available for our attorney clients

Please contact us if you would like more information about our FCE protocol or would like to set up educational opportunities that can include continuing education credit for nurses, doctors and attorneys.

Functional Job Analysis & Job Descriptions (FJA/FJD)

Traditionally job descriptions are created by staff who have the best of intentions, but minimal understanding of a job as it relates to the human being performing it. E3 creates job descriptions that reflect the exact functional, physical requirements of every job. E3 uses licensed Physical or Occupational Therapists to create each FJD. Therapists use on site observation, questionnaires, interviews and video recordings in order to gather all applicable information. This information is analyzed, then confirmed by current employees and supervisors and ultimately synthesized into a working document. Without all these steps, job descriptions are generally not legally valid.

A thorough Functional Job Description (FJD) is invaluable for many reasons:

  • Many times an accurate description will help weed out unqualified job candidates before they even apply
  • Expedites training by defining physical expectations for each new employee
  • Reminds current workers the level of performance they are required to maintain
  • Ensures an easier transition from one job to another for promoted, demoted or transferred employees
  • Makes return-to-work therapy for injured employees drastically more efficient

E3 uses FJDs as the basis for our Pre-Work Screens and job-specific FCEs. It also provides a blueprint for our unique Work Hardening & Conditioning program.

In-Treatment Validity of Effort Testing

If changing the specific therapy approach doesn’t beget improvement, E3 addresses behavioral issues that may be affecting outcomes of treatment. When present, these issues often go unaddressed until after the injured worker has reached maximum medical improvement. Some therapists note a patient's effort in progress notes, but do so subjectively which means very little is ever done to change the treatment or the patient’s mindset toward treatment. Naturally, this lengthens recovery periods, sometimes to the point where MMI is "reached" solely out of frustration.

E3 does not believe use of validity of effort testing should be reserved for FCEs alone. That is why, in cases where progress plateaus, E3 incorporates objective validity of effort testing into our bi-weekly functional progress notes. This not only verifies the accuracy of the client's physical capabilities each step of the way, but allows for behavioral issues to be addressed in a supportive environment thereby maximizing rehabilitation potential.

Job-Centric Work Conditioning/Hardening

  • Each patient entering E3’s work conditioning/hardening system is given a unique program specifically designed to move them safely and effectively towards their pre-injury baseline
  • E3 utilizes a combination of free weights, specialized machines, neuro-adaptive exercise, and most importantly work simulation activities (when possible, with actual jobsite materials) to achieve the optimum outcome
  • E3 management reviews every progress report on every patient
  • Our highly trained staff manipulates the volume, intensity, and duration of activity on a continuous basis to maximize results
  • The client's physical abilities are formally tested on a bi-weekly basis and compared to their job's critical physical demands when possible
  • Everyone at E3 ensures the patient is mentally invested in getting well and putting forth an effort, just like they would be required to do at their workplace.

Every job has critical physical demands that must be met in order for the client to return to unrestricted duty. Before beginning therapy, E3 can identify these demands through a combination of pre-existing job descriptions, employee/supervisor interviews/questionnaires or "micro" job analysis using digital video. E3 can also create a full-fledged Functional Job Analysis/Description to identify the essential functions. This approach ensures that return-to-work decisions are made based on the client's ability to perform essential functions rather than arbitrary ratings of strength, range of motion, or pain levels thus reducing both direct and indirect costs associated with a workplace injury.

On-Site Industrial Rehabilitation Program

E3’s on-site services are the same as our Post-Injury PT/OT and Job-Centric Work Conditioning/Hardening systems, save for the fact they're done at the worksite.

If the therapist is on-site regularly (be it every day, a couple times a week or even just once a month) they can also be used to apply solutions arrived at via E3’s On-Site Injury Prevention program.

On-Site Injury Prevention

Small nagging injuries often become major, expensive ones. Most of those issues can, and should, be identified and rectified without ever filing a ‘recordable’ injury.

E3’s therapist becomes a de-facto member of your risk management team working closely with human resources and supervisory staff to identify and treat injuries before they become ‘recordable’ by providing manual therapy for pre-emergent injuries, creating stretching programs, ensuring sound ergonomics company-wide, monitoring employee’s body mechanics, etc.

By regularly surveying current employees E3 will identify and address pre-emergent injuries in individuals and general trends among groups of workers (by shift, location, supervisor, time of day, etc.) This has a dual effect: it "catches" injuries before they happen in individuals and it increases productivity by identifying performance inconsistencies among groups of workers.

The surveys are quick (a few minutes on-line) and easily afforded in nearly any HR budget; the resulting information is priceless:

  • Identification of ‘at risk’ groups of employees
  • Detection of pre-emergent worker issues (identifying where capacity/demand imbalances exist)
  • Ability to provide simple and timely non-medical interventions based on each individual’s unique needs
  • Optimization of demand/capacity balance where compromised
  • Ability to monitor recovery trajectories
  • Ability to more effectively case manage high risk workers
  • Facilitation of employee "ownership" in their own health and well being on the job and away from it

Post Injury Physical/Occupational Therapy

During the early stages of treating a workplace injury, the approach is not dissimilar from that used in relation non-workplace injuries. Our highly trained physical and occupational therapists offer a supportive, friendly and comfortable environment for all their patients. Many companies are more concerned with their therapists productivity than their efficacy. E3, naturally, wants their therapists to be productive, but when it comes to work-related injuries, their willingness to take a little extra time with a patient is often the reason the patient can start Job-Centric Work Conditioning/Hardening sooner than they might otherwise.

Pre-Work Screens (PWS)

The E3 Pre-Work Screen is the gold standard in the industry.

  • E3 bases their Pre-Work Screens (a.k.a. Performance Profiles, Lift Tests, Post-Offer/Pre-Placement Physical, etc.) on an in-depth Functional Job Analysis/Description that is validated by current employees and supervisors, ensuring the screening process is legally viable.
  • Based on the new-hires PWS results, employers can confidently slot employees into specific jobs, they can modify job duties or they can rescind the offer of employment.
  • E3 has each new-hire replicate what they'll be doing on the job. Often using materials from the actual worksite, never relying on machine-based measurements that are not job-relevant nor specific enough to provide useful hiring information.
  • E3 therapists perform each screening one-on-one with the job candidate to ensure each new-hire can, in fact, safely perform the essential functions of the job and educate the job-candidate on proper body mechanics as they relate to each specific job.
  • E3 can do each PWS by appointment (the new-hire doesn't end up waiting) or, in instances where an E3 client is in a hiring mode – seasonal work generally – E3 can perform screenings on-site.
  • Results are communicated in real time to the employer, generally Human Resources
  • E3 has multiple partnerships in place to provide single-source billing for Drug/Alcohol Testing and Background Checks. E3 also works with many doctors to provide medical physicals, DOT physicals, vision/hearing tests, etc.
  • E3 is ALWAYS compliant with ADA and EEOC

Single Point of Contact

Good communication can make all the difference between effective case resolution and costly delays in returning to work. Treating therapists are often difficult to reach, for that reason, E3 has a designated single point of contact for all our referral sources.

This individual is available to answer any or all questions related to the care of the injured employee. They act as a liaison between treating therapists and the case manager, doctor, adjuster, etc. and, perhaps most importantly, they problem-solve difficult cases by providing perspective a treating therapist often lacks due to proximity with the patient.